CHAPTER 9

NERVOUS SYSTEM

GENERAL ANATOMY
AUTHOR: DR YOGESH SONTAKKE,
JIPMER, PONDICHERRY
 As per:
Competency based Undergraduate curriculum
•AN7.1: Describe general plan of nervous system with
components of central, peripheral, and autonomic nervous
systems.
•AN7.2: List components of nervous tissue and their functions.
•AN7.3: Describe parts of a neuron and classify them based on
number of neurites, size, and function.
•AN7.4: Describe structure of a typical spinal nerve

Human Anatomy/Yogesh Sontakke 2

 As per:
Competency based Undergraduate curriculum
•AN7.5: Describe principles of sensory and motor innervation of
muscles
•AN7.6: Describe concept of loss of innervation of a muscle with
its applied anatomy
•AN7.7: Describe various types of synapses
•AN7.8: Describe differences between sympathetic and spinal
ganglia.

Human Anatomy/Yogesh Sontakke 3

 INTRODUCTION
∙ The nervous system is most evolved part of the human body. It integrates and
controls most of the body functions, hence it is termed as ‘master system’ of the
body.
∙ Some major functions of the nervous system are as follows:
1. Sensory reception - receives sensory input from both the internal and external
environment, allowing the body to perceive and react to various stimuli.
2. Information integration - nervous system processes and integrates the received
sensory information, enabling the brain to make sense of the surroundings and
respond appropriately.
3. Muscle control - oversees the intricate control of muscles throughout the body,
regulating voluntary and involuntary movements.
4. Glandular control - nervous system governs glands and their secretions,
influencing the release of hormones and various physiological processes.
 INTRODUCTION
5. Homeostasis maintenance - plays a crucial role in maintaining the body's
internal balance, ensuring that essential physiological parameters, such as
temperature and blood pressure, remain within a narrow range.
6. Cognitive functions - nervous system is instrumental in establishing and
sustaining mental activities, including thinking, learning, memory, and
emotional responses.

These functions collectively enable the nervous system to facilitate

communication within the body, adapt to changing conditions, and support
overall physiological and cognitive well-being.
 INTRODUCTION
∙ The weight of brain is about 1500 to 2000 g and it contains about 100 billion
neurons.
∙ The nervous tissue consists of:
1. Neurons
2. Neuroglial cells (supporting cells)
 DIVISIONS OF NERVOUS SYSTEM
∙ The nervous system can be classified in two divisions on the anatomical or functional
basis.

Anatomical (descriptive) divisions:

∙ Anatomically, the nervous system is divided into two parts: Central and peripheral
nervous systems.

A. Central nervous system (CNS):

– It consists of the brain and spinal cord.

– It is responsible for integration, processing and coordinating sensory inputs and

generation of motor output.

– It is the seat of higher functions such as intelligence, memory, learning, and emotions.
 DIVISIONS OF NERVOUS SYSTEM
B. Peripheral nervous system (PNS):

– Peripheral nerves: They consist of

▪ 12 pairs of cranial nerves

▪ 31 pairs of spinal nerves
▪ Autonomic (splanchnic) nerves.

Fig. 9.2: External features of brainstem (anterior view)

Ganglia - Dorsal root ganglia of spinal nerves, cranial nerve
root ganglia, and autonomic ganglia
– It carries sensation to CNS and gives efferent fibers to
muscles, glands, and blood vessels.

Fig. 9.3: Spinal cord with 31 pairs of spinal nerves

 DIVISIONS OF NERVOUS SYSTEM
Functional (physiological) divisions:

∙ Functionally, the nervous system is divided into two divisions:

1. Afferent division - gives sensory input to the central nervous system.
2. Efferent division - carries motor signals away from the central nervous system. It is
further subdivided as follows:
a. Somatic nervous system (SNS) - voluntary control over skeletal muscles.
b. Automatic nervous system (ANS) - involuntary control over the heart, smooth
muscles, glands, and blood vessels and includes sympathetic and parasympathetic
nervous system.
 Table 9.1: Major parts of brain
Part Subparts
Cerebral hemisphere Cerebral cortex

Frontal lobe

Parietal lobe

Occipital lobe

Temporal lobe

Basal ganglia, claustrum, insular cortex

Limbic system

Internal capsule
Diencephalon Thalamus, hypothalamus, subthalamus,

epithalamus, metathalamus
Brainstem Midbrain
Fig. 9.1: Superolateral surface of the right cerebral hemisphere
Pons

Medulla oblongata
Cerebellum Cerebellar cortex

Cerebellar nuclei
Table 9.2: Cavities of brain and spinal cord

Part of brain Cavity

Cerebral hemisphere Lateral ventricle

Diencephalon 3rd ventricle
Mesencephalon (Midbrain) Cerebral aqueduct
Rhombencephalon 4th ventricle
(hindbrain)
Spinal cord Central canal of spinal cord
Terminal ventricle
Flowchart 9.1: Anatomical divisions of nervous system
Flowchart 9.2: Functional divisions of nervous system
 STRUCTURE OF NEURON
∙ It is the structural and functional unit of the nervous system.
∙ They are grouped as sensory neurons (carry information toward the
nervous system), motor neurons (carry information away from the
nervous system), and interneurons (communicate information from
sensory to motor neurons).
∙ More than 99% neurons are interneurons (intercalated neurons).

Structure of Neuron:

∙ Neuron has a body, axon, dendrites, and synaptic junctions.

Structure of Neuron:
∙ Neuron has a body, axon, dendrites, and synaptic junctions.

Fig. 9.4: Parts of neuron

 STRUCTURE OF NEURON
Body/Perikaryon:
• Cell body of a neuron is also called
perikaryon or soma. It consists of
the nucleus, perinuclear cytoplasm,
and cell membrane.
∙ Cytoplasm - contains a large
central vesicular nucleus,
numerous mitochondria, rough
endoplasmic reticulum, and Golgi
complex.
∙ Nucleus is euchromatic (lightly
stained) with 1–2 nucleoli. Fig. 9.4: Parts of neuron
∙ New concept - Neurons have centrioles, but they cannot
divide. (Previous concept: Neurons do not have centrioles).
∙ Cytoplasm shows the presence of Nissl bodies.

∙ Nissl bodies/substance/granules - Cytoplasm of neurons

shows the presence of granular basophilic cytoplasmic
material called Nissl bodies. On electron microscopy, Nissl
bodies are stacks of the rough endoplasmic reticulum.

Fig. 9.4: Parts of neuron

 STRUCTURE OF NEURON
∙ It contains many neurofibrils
(microtubules and microfilaments).
Centrioles may help in the production
of neurofibrils.
∙ Some of the neurons also contain
melanin pigment (substantia nigra) and
lipofuscin pigments.

Fig. 9.4: Parts of neuron

 STRUCTURE OF NEURON
• Dendrites:

∙ They are multiple, short, thick,

tapering processes. Nissl granules
extend into the dendrites.
∙ Branching pattern of dendrites
(arborization) is called dendritic tree.
Dendrites receive information and
carry it toward the body of the cell.

Fig. 9.4: Parts of neuron

 STRUCTURE OF NEURON
Axons:

∙ They is a single, long, and thin process of

neuron. Axons carry information away from the
neuron body and have a uniform diameter.
Axon is commonly termed as ‘nerve fiber’.
Axon is devoid of Nissl granules.

Neurites:
∙ Processes arising from the cell body of
a neuron are called neurites. They are
axons and dendrites.
Fig. 9.4: Parts of neuron
∙ Axoplasm - cytoplasm in axon and axolemma is its
cell membrane.
∙ Axoplasmic transport (axonal transport system) -
axons do not contain rough endoplasmic reticulum,
the protein synthesized in the cell body needs to be
transported across axon.

∙ Axon hillock - a part of cell body that is devoid of

Nissl granules and gives rise to axon.
∙ New concept - Some cells of the olfactory bulb and
dentate gyrus of the hippocampus are neural stem
cells, and they can generate new neurons.
∙ Initial segment - the initial nonmyelinated part of
axon between axon hillock and myelinated part of
axon. An action potential is generated at initial
segment.

Fig. 9.4: Parts of neuron

 STRUCTURE OF NEURON
∙ New concept - Periaxoplasmic plaques – these are axon terminals that
have protein synthesis machinery (rER). These are involved in the
process of neuronal cell memory.
∙ Telodendria - terminal branching part of the axon. It has terminal
boutons or presynaptic knobs.
∙ The gray matter consists of mainly nerve cell bodies, whereas the white
matter consists of mainly nerve fibers.
Table 9.3: Differences between axon and dendrites
Q. List the differences between axon and dendrites.

Axon Dendrites
It is a single, long, thin process of These are multiple, short, thick
neuron processes of neuron
It carries signal away from nerve It carries signal toward nerve cell body
cell body
Axon rarely branches. Branches of Branches of dendrite form dendritic
axon form axon terminals tree
Diameter: Uniform Diameter: Taper toward distal end
(away from neuron)
Does not contain Nissl granules Contain Nissl granules
 CLASSIFICATION OF NEURON
Q. Classify the neurons.

A. Based on number of processes/polarity:

∙ They are classified as unipolar,

pseudounipolar, bipolar, and multipolar
depending on number of processes.

Fig. 9.5: Types of neurons

1. Unipolar neurons - only one cell process,
mostly dendrite.
Examples:
a. Neurons of mesencephalic nucleus of
trigeminal nucleus
b. Some neurons during embryonic life.
2. Pseudounipolar neurons - neurons have only
one process (axon) that divides into two
branches, peripheral and central.

Fig. 9.5: Types of neurons

 CLASSIFICATION OF NEURON
Examples:
a. Dorsal root ganglia
b. Sensory ganglia of cranial nerves.
New concept - Unipolar and pseudounipolar
neurons are under the same category.

Fig. 9.5: Types of neurons

3. Bipolar neurons - two processes: One axon and
another dendrite.
Examples:
a. Olfactory epithelium
b. Retina
c. Ganglionic cells of vestibular and spiral
ganglia (VIII cranial nerve).
4. Multipolar neurons - multiple processes – one
axon and many dendrites. These are present in
the spinal cord, cerebellum, and cerebrum as
motor neurons and interneurons.

Fig. 9.5: Types of

neurons
 CLASSIFICATION OF NEURON
Examples:
a. Stellate (star-like) cells
b. Purkinje (flask-shaped) cells
c. Pyramidal (triangular) cells.

B. Based on length of axon

∙ Based on length of the axon, neurons are grouped as Golgi type I and Golgi type II
neurons.
1. Golgi type I neurons have long axons.
Examples:
b. Pyramidal cells of motor cortex in cerebrum.
c. Anterior horn cells of spinal cord
d. Purkinje cells of cerebellum
 CLASSIFICATION OF NEURON
2. Golgi type II neurons (microneurons) - short axons. They are abundant in the cerebral and
cerebellar cortex.
Example:
a. Granule Cells in the Cerebellum
b. Basket Cells in the Hippocampus
c. Stellate Cells in the Cerebral Cortex
d. Amacrine Cells in the Retina
e. Golgi Cells in the Cerebellum

C. Physiological classification:

∙ Based on function, neurons are classified as sensory and motor neurons.

1. Sensory neurons - receive impulses and carry signals to the nervous system.
2. Motor neurons - carry impulses from the nervous system to muscles and glands.
Flowchart 9.3: Classification of neurons
 NEUROGLIA
Q. List the types of neuroglia.

∙ Supporting cells of the nervous system are called neuroglia or glia.

∙ Functions of neuroglial cells:
1. Support and structural maintenance of nervous tissue
2. Insulation for nerve conduction
3. Nutrient supply to neurons
4. Waste removal
5. Immune defense and phagocytosis
6. Regulation of extracellular environment
7. Modulation of synaptic activity
 NEUROGLIA
∙ Neuroglia are grouped as follows :
1. Central neuroglia (neuroglia of the central nervous system)

2. Peripheral neuroglia (neuroglia of the peripheral nervous system).

CENTRAL NEUROGLIA:

∙ These are supporting cells of the central nervous system. There are four types of
central neuroglia:
1. Astrocytes
2. Oligodendrocytes
3. Microglia
4. Ependymal cells.
 NEUROGLIA
∙ They support embryonic (developing) neurons as well as provide physical support
after development. Radial glial cells direct the migration of neurons during
development.

Astrocytes:

∙ These are star-shaped cells (largest neuroglia) and they have numerous processes.
There are two types of astrocytes: Fibrous and protoplasmic.
∙ Fibrous astrocytes - fewer and thin processes and are mostly found in the white
matter of the CNS.
∙ Protoplasmic astrocytes - numerous, short, thick, branching cytoplasmic processes.
They are mostly found in gray matter.
 NEUROGLIA
∙ Functions of astrocytes:
– They provide physical support to neurons.
– They maintain a favorable metabolic environment for neurons by removing
neurotransmitters from synapses.
– They help in the maintenance of blood–brain barrier.
– Glia limitans - membrane-like barrier on external surfaces of brain and spinal
cord. It is produced by protoplasmic astrocytes.
– Astrocytes maintain K+ ion concentration in extracellular spaces of the brain and
spinal cord by potassium spatial buffering.
– Gliosis - proliferation of astrocytes to heal the damaged zones of nervous tissue.
– Fibrous astrocytoma (tumor) accounts for about 80% of brain tumors in adults.
 NEUROGLIA
Oligodendrocytes:

∙ They are small, round cells and have a few cytoplasmic processes (oligo = scanty, in
Greek).
∙ Function - produce myelin sheaths in CNS. One oligodendrocyte myelinates many
adjacent axons or sometimes the same axons at different places.
∙ Note: Nonmyelinated neurons are not enclosed by processes of oligodendrocytes in
CNS.
 NEUROGLIA
Microglia:

∙ These are the smallest neuroglial cells.

∙ Function - phagocytic cells. They proliferate specifically in nervous tissue injuries and
diseases. Microglia form a part of mononuclear phagocytic system in CNS.

Flowchart 9.4: Types of neuroglia

∙ Current update - remove bacteria, cancer (neoplastic) cells, and dead nerve cells.
∙ Gitter or Hortega cell - lipid-laden microglial cell observed at the edge of healing brain infarcts. It is also called
compound granule cell, gitterzelle, mesoglea, or perivascular glial cell.

Flowchart 9.4: Types of neuroglia

 NEUROGLIA
Ependymal cells:

∙ The cavities of the nervous system are lined by epithelium-like ependymal cells.
Ependymal cells are cuboidal to columnar in shape and arranged in a single layer.

Flowchart 9.4: Types of neuroglia

∙ There are three types of ependymal cells: Ependymocytes, choroid epithelial cells, and
tanycytes.
∙ Functions:
1. Exchange of substances between the brain and cerebrospinal fluid at the brain–CSF
barrier.
2. Choroid plexus secretes CSF.

Flowchart 9.4: Types of neuroglia

 NEUROGLIA
PERIPHERAL NEUROGLIA:

Schwann cells:

• (Theodor Schwann, 1810–1882, German physiologist):

∙ They are also called neurolemmocytes. These are present only in peripheral nervous system.
∙ Functions - produce myelin in peripheral nervous system.

Fig. 9.5: Various neuroglial cells

 NEUROGLIA
Satellite cells:

∙ In ganglia (collection of neuronal cell bodies outside the CNS), neuronal bodies are
surrounded by a layer of flat cuboidal cells called satellite cells.
∙ It gives passage to nerve cell processes.

Fig. 9.5: Various neuroglial cells

∙ In sensory ganglia, the satellite cell capsule is nearly complete as sensory neurons do not synapse in ganglia.
∙ In autonomic ganglia, the satellite cell capsule is not complete as autonomic neurons have synapses in the
ganglia.
∙ Functions - Protection and support ganglionic neurons.

Fig. 9.5: Various neuroglial cells

 SYNAPSE
∙ Neuron conveys messages to another cell (neuron/ effector cell) through a synapse. Synapse is the junction
between neurons.

Morphological Classification:

∙ Depending on components of the synapse, they are classified as follows :

1. Axodendritic synapse - most common type of synapse. In the axodendritic synapse, the axon of one neuron
synapses with the dendrite of another neuron.
2. Axosomatic synapse - conveys impulses to soma (body) of another neuron.
3. Axoaxontic synapse - synapse between two axons.
4. Dendroaxonic synapse - synapse between dendrite of presynaptic neuron and axon of postsynaptic neuron. It is
seen in some parts of thalamus.
5. Dendrodendritic synapse - synapse between two dendrites.
6. Somatosomatic synapse - synapse between bodies of neurons.
7. Somatodendritic synapse - synapse between soma and dendrite of postsynaptic neurons.
 SYNAPSE
∙ Boutons en passant - Presynaptic neuron makes
several contacts with postsynaptic neuron. These
contacts are called boutons en passant (means buttons
in passing in French).
∙ Bouton terminal - Enlarged terminal end of axon is
called bouton terminal (means terminal button in
French).

Chemical and Electric Synapses:

∙ Based on mechanism of conduction of nerve

impulses, synapses are classified as chemical or
electrical.

Chemical synapses:

∙ It involves release of chemical (neurotransmitter)

from preganglionic neurons for conduction of
Fig. 9.7: Structure of chemical synapse
impulse.
 SYNAPSE
Structure of chemical synapse:
∙ Components of chemical synapse are as follows:
1. Presynaptic element (presynaptic knob) - It is the part of
presynaptic neuron that releases neurotransmitter.
2. Presynaptic element stores neurotransmitter in synaptic
vesicles.
3. Synaptic cleft - It is a narrow gap (20–30 nm) between
presynaptic and postsynaptic neurons. Neurotransmitter
needs to cross synaptic cleft.
4. Postsynaptic membrane/process - It is a membrane of
postsynaptic neuron that has receptors for
neurotransmitters.

Fig. 9.7: Structure of chemical synapse

Electrical synapses:
∙ Electric synapse involves the passage of electric signal from one cell to
another cell by gap junctions.
∙ Electrical synapses do not involve neurotransmitter release.
∙ Examples: Gap junctions of cardiac and smooth muscles.
Flowchart 9.5: Morphological classification of synapse

Fig. 9.6: Types of synapse

Flowchart 9.6: Classification of synapse based on the mode of transmission
 Some Interesting Facts
∙ Merkel epidermal cells, auditory receptors, and taste buds are epithelial
receptors, whereas the olfactory epithelium is a neuroepithelial receptor.
∙ Neurotransmitters once released in synaptic cleft may be degraded by
enzymes or may be taken back (uptake) by presynaptic neurons. For
example, catecholamine action is terminated by their uptake.
∙ Clinical fact - Amphetamine and cocaine inhibit catecholamine uptake
and prolong their actions. Acetylcholine is degraded by acetylcholine
esterase.
 Some Interesting Facts
∙ Clinical fact - Many poisons (pesticides) and other drugs inhibit the
action of acetylcholine esterase and cause prolonged muscle contraction.
∙ Axon-hillock - most excitable part of the neuron.
∙ Astrocytes - largest neuroglia, whereas microglia are the smallest.
∙ Axodendritic synapse - most numerous synapses in the body.
∙ Pacinian corpuscles - largest sensory receptors.
 NEUROTRANSMITTERS
Q. Write a short note on neurotransmitters.

∙ These are the substances released from presynaptic neurons that traverse the synaptic cleft to reach the
postsynaptic membrane.
∙ They may depolarize (activate) or hyperpolarize (inhibit) the postsynaptic membrane.
∙ The neurotransmitters are grouped based on their chemical nature into the following groups:
1. Acetylcholine
2. Amines: Noradrenaline, adrenaline, serotonin dopamine, histamine
3. Amino acids: Gamma aminobutyric acid (GABA), glycine, glutamate, aspartate
4. Neuropeptide: substance P, endorphins, enkephalins.
∙ Neurotransmitters bind with receptors to produce their desire effects such as:
1. Acetylcholine: ACh binds with cholinergic receptors
2. Adrenaline and noradrenaline bind with adrenergic receptor.

• Note: Acetylcholine esterase (AChE) immediately hydrolyses secreted acetylcholine into acetic acid and choline. Viva
 Clinical Integration
• Myasthenia gravis - autoimmune disease in which antibodies destroy own
acetylcholine receptors in muscle fibers. It results in muscular weakness, fatigue,
ptosis (drooping of upper eyelid), flaccid muscle paralysis.

• Treatment - Anticholinesterase drugs (e.g. neostigmine) enhance acetylcholine

concentration and hence, useful in treatment of myasthenia gravis.
 MYELIN SHEATH
∙ It is an insulating sheath surrounding the axons of myelinated nerve cells. Myelin is
produced by oligodendrocytes in CNS and Schwann cells in PNS. Myelin consists of
lipids (80%), proteins, and water.

Formation of myelin sheath:

∙ In the process of myelination, the axon initially lies in a groove of a Schwann cell.
∙ Sheet-like extension of mesaxon surrounds axon spirally and cytoplasm of mesaxon
gets squeezed. Thus, it results in the formation of myelin sheath (lipid layer) around
axon.
∙ Outside the myelin sheath, thin layer of cytoplasm of Schwann cell is present along
with surrounding cell membrane of Schwann cells, now called neurilemma or
neurilemmal sheath.
 MYELIN SHEATH
∙ Schmidt-Lanterman clefts - small pockets of
cytoplasm in the inner layers of the myelin
sheath. Usually, cytoplasm gets squeezed
out of the myelin sheath during the
wrapping of mesaxon around the axon.
∙ Nonmyelinated axons are covered by
Schwann cells in PNS. Single Schwann cell
Fig. 9.9: Role of Schwann cell in the protection of
is invaginated by multiple nonmyelinated nonmyelinated axon
axons. Note: One Schwann cell surrounds multiple
nonmyelinated nerve fibers.
∙ The gap between the segment of myelin and
between adjacent Schwann cells is called
nodes of Ranvier or incisura myelini (Louis
Antoine Ranvier, French Anatomist,
1835–1922). Nodes of Ranvier increases the
rate of nerve conduction by saltatory
conduction.
∙ Internode is a segment of myelin sheath
between adjacent nodes of Ranvier.
∙ Thickness of myelin sheath depends on axon
diameter of axon and not on Schwann cell.
∙ A single Schwann cell protects many
nonmyelinated axons. Fig. 9.8: Process of myelination
 MYELIN SHEATH
Functions of myelin sheath:

1. Protection and physical support to

axons
2. Insulation of axons
3. Increases nerve conduction by
saltatory conduction
4. Neurilemmal sheath plays a major
role in nerve regeneration.

Fig. 9.8: Process of myelination

 Clinical Integration
• Enuresis (bed-wetting) - It is observed in the first 3–6 years of life. It occurs up to the completion of
myelination of corticospinal tract fibers that control the emptying of the urinary bladder.

• Embryological basis - myelination begins before birth and continues for a few years after birth.
Enuresis is normal in infants.
• One Schwann cell can produce a myelin sheath around a small segment of one axon. One
oligodendrocyte can produce a myelin sheath around many axons. Hence, the neurilemmal sheath is
present only in the peripheral nervous system (cell membrane of Schwann cell) and not in CNS as a
single oligodendrocyte does not cover one axon. Because of the absence of neurilemmal sheath in CNS,
regeneration of neuron is not possible in CNS.
 MYELIN SHEATH
Classification of nerve fibers:

∙ Based on the diameter of the nerve fibers, they are grouped as follows:

Group A - Highly myelinated fibers

Group B - Thinly myelinated fibers (up to 3 μm thick)

Group C - Nonmyelinated fibers (about 0.2–1.5 μm thick).

 CONDUCTION OF ACTION POTENTIAL
∙ Ionic concentration within the neuron and extracellular fluid creates resting
membrane potential across the neuronal plasma membrane (RMP). At resting
membrane potential, the neuronal plasma membrane is polarized. Resting membrane
potential is always negative (–70 mV).
∙ The resting membrane potential is negative because of the high concentration of
cations (for example, Na+ ions) outside the nerve fibers in the extracellular fluid.
∙ Action potential - a sequential change in
membrane potential that develops on
activation or stimulation of the nerve cell rise
in membrane potential which soon comes
back to resting membrane potential.
∙ It involves two phases:
1. Depolarization – increase in membrane
potential up to +40 mV)
2. Repolarization – decrease in or
restoration of membrane potential.
Fig. 9.10: Conduction of action potential along an axon. A. In
myelinated axon, B. in nonmyelinated axon
 CONDUCTION OF ACTION POTENTIAL
∙ Action potential is generated at one point of the neuronal plasma membrane, and it
propagates across this membrane. The speed of conduction of action potential
depends on the myelination of the nerve fibers.
∙ Thickness of myelin is directly proportional to the conduction of action potential.
∙ Saltatory conduction (saltare = to leap in Latin) - jumping conduction of action
potential from one node of Ranvier to other nodes of Ranvier. In thick myelinated
motor fibers (alpha fibers), the speed of conduction is very high (70–120 meters per
second).
 NERVE INJURIES
• Based on the severity of the damage, nerve injuries are classified as:

1. Neurotmesis – both axon and myelin sheath damaged

2. Axonotmesis – only axon is damaged, myelin sheath is intact
3. Neuropraxia – both axon and myelin sheath are preserved.

• Nerve regeneration occurs in the peripheral nerve in case of neuropraxia and axonotmesis, but in case
of neurotmesis, nerve regeneration does not occur.

NERVE DEGENERATION AND REGENERATION:

Q. Write a short note on Wallerian degeneration.

• Injury to the axon with myelin sheath follows two events:

1. Degeneration of nerve fiber

2. Regeneration of nerve fiber

 NERVE INJURIES
Degeneration of nerve fiber:

• Definition - These are the changes that occur in the nerve cell following the injury. These include changes in the
nerve cell body and changes in the nerve fiber.
• Changes in nerve fiber - These includes:

1. Wallerian degeneration - changes in the distal segment. It includes disintegration of myelin and degeneration of
nerve fibers.

2. Degeneration of proximal segment up to the nearest node of Ranvier.

• Changes in the nerve cell body - Due to loss of neural activity after injury, the cell body undergoes the following
changes:

1. Chromatolysis – disintegration of Nissl bodies

2. Cell swelling

3. Nucleus shifts to an eccentric position.

 NERVE INJURIES
Regeneration of nerve fiber:

∙ The regeneration of nerve fibers is a very slow process. It

begins after two weeks after injury. It involves:
1. Process of regeneration - macrophages remove the
degeneration debris by phagocytosis.
2. Schwann cell proliferation - The Schwann cells proliferate
and fill the empty space created by disintegration of axon
and the myelin. Schwann cells also fill the gap between
proximal and distal segments of axon.
3. Axonal growth - The ends of the axon give rise to multiple
sprouts that enter the endoneurial tube of proliferated
Schwann cells.
4. Elongation of axon - One of the axonal sprouts continues
elongation under the guidance of Schwann cells to reach Fig. 9.11: Degeneration and regeneration of a
the end organ. nerve fiber (Wallerian degeneration)
5. Regeneration of myelin - Surrounding Schwann cells reform
the myelin sheath to restore the function completely

Fig. 9.11: Degeneration and regeneration of a nerve fiber

(Wallerian degeneration)
 Some Interesting Facts
• Rate of nerve regeneration/growth - 3.5 to 4.5 mm per day.

• Proper nutrition is essential for faster nerve regeneration.

 Clinical Integration
Neuroma - benign tumor. Sometimes, if the distance between the cut ends
of nerve fibers is more, then the gap is filled with fibrous tissue which
contains growing axonal sprouts. This mass forms neuroma. It is painful.
 PERIPHERAL NERVES
∙ The peripheral nerves form a communication between the organs and the central
nervous system.
∙ It consists of two components:
1. Somatic nerves
2. Autonomic (splanchnic or visceral) nerves.
∙ The peripheral nerves include:
– 12 pairs of cranial nerves
– 31 pairs of spinal nerves
– Autonomic (splanchnic) nerves - Sympathetic and parasympathetic nerves
 PERIPHERAL NERVES
• The peripheral nerve contains the following nerve fibers:

1. Somatic afferent (sensory) fibers to carry sensory inputs from skin, bones,
muscles, and joints to the CNS.
2. Somatic efferent (motor) fibers to carry motor impulses to the skeletal muscles.
3. Visceral afferent (sensory) fibers to carry input from the organ and blood vessels
to the CNS.
4. Visceral efferent (motor) fibers to carry impulses from CNS to glands, smooth
muscle of organs and blood vessels, and cardiac muscles.

• Note: The bundle of nerve fibers in CNS is called tract.

 PERIPHERAL NERVES
Structures of peripheral nerve or nerve fiber

Q. Write a short note on structure of peripheral nerve (TS).

∙ The peripheral nerve is a collection of many nerve fibers held together by connective
tissue. The concept of nerve fiber is confusing as it does not mean a connective tissue
fiber (Fig. 2.1, Flowchart 2.1).
∙ Nerve fiber with Schwann cells and basal lamina is the basic structural unit of the
peripheral nerve.
∙ Each single nerve fiber is surrounded by a thin connective tissue called the
endoneurium.
∙ Endoneurium consists of the loose connective tissue with collagen fibril, few
fibroblasts, occasional mast cells, and macrophages.
 PERIPHERAL NERVES
∙ A group of nerve fibers forms a nerve fascicle or bundle. Each nerve fascicle is
surrounded by a layer of specialized connective tissue called perineurium.
∙ Perineurium is made-up of flattened (squamous) perineurial cells. Perineurial cells
are connected with each other by tight junctions and hence, form a blood–nerve
barrier.
∙ Epineurium surrounds entire peripheral nerve. It contains blood vessels that supply
the nerve.

• Note: Blood vessels (vasa nervorum) are present only in epineurium and perineurium.
Endoneurium does not have blood vessels. Nerve fibers receive nutrition by diffusion
through endoneurium.NEXT, Viva
Flowchart 9.7: Peripheral nerve
 PERIPHERAL NERVES
Cranial Nerves

∙ There are 12 pairs of cranial nerves

which arise from the brain. They are
designated by Roman numerals I to XII.
∙ The cranial nerves and their main
functions are listed in Table.
∙ Trigeminal nerve is the largest cranial
nerve and vagus is the longest. Trochlear
nerve is the smallest cranial nerve.
Fig. 9.12: Structure of peripheral nerve
∙ All the cranial nerves emerge from the ventral aspect of the brainstem except trochlear nerve, which emerges
from the dorsal aspect.
∙ All the spinal nerves supply skin except the first cervical spinal nerve.

Fig. 9.13: Practice figure: Histology of peripheral nerve

(transverse section, H&E stained, low magnification above, high
magnification below)
Table 9.4: Cranial nerves and their main functions
Cranial Nerve Primary Functions
I Olfactory nerve Sense of smell
II Optic nerve Vision
III Oculomotor nerve Eye movement (most eye muscles), pupil constriction
IV Trochlear nerve Eye movement (superior oblique muscle)
V Trigeminal nerve Sensations of the face, chewing movements
VI Abducent nerve Eye movement (lateral rectus muscle)
Facial expression, taste (anterior two-third of tongue), Secretomotor
VII Facial nerve supply to submandibular, nasal and lacrimal glands
VIII Vestibulocochlear nerve Hearing, balance (equilibrium sensation)
Swallowing, taste (posterior one-third of tongue), Secretomotor
IX Glossopharyngeal nerve supply to parotid gland
Swallowing, talking, parasympathetic nervous system functions
(heart, lungs, digestive system), taste sensation from posterior most
X Vagus nerve part of tongue
Accessory part joins vagus nerve to supply muscles of larynx,
pharynx, and soft palate.

XI Accessory nerve (spinal accessory nerve) Spinal part: supply two muscles: trapezius, sternocleidomastoid
XII Hypoglossal nerve Muscles of tongue (speech, swallowing)
 PERIPHERAL NERVES
Spinal Nerves:

∙ There are 31 pairs of spinal nerves which arise

from the spinal cord. These are as follows:
▪ 8 pairs of cervical nerves (C1 to C8)
▪ 12 pairs of thoracic nerves (T1 to T12)
▪ 5 pairs of lumbar nerves (L1 to L5)
▪ 5 pairs of sacral nerves (S1 to S5)
Fig. 9.14: Typical thoracic spinal nerve
▪ 1 pair of coccygeal nerves
 PERIPHERAL NERVES
Typical Spinal nerve:

∙ A typical spinal nerve arises from the spinal

cord by two roots:
1. Anterior root - It is motor and arises from
anterior horn cells.
2. Posterior root - It is sensory and possesses
a posterior (dorsal) root ganglion which has
nerve cell bodies of sensory nerve fibers.
Fig. 9.14: Typical thoracic spinal nerve
 PERIPHERAL NERVES
∙ The two roots come out of the vertebral canal
through the intervertebral foramen and then
join each other to form nerve trunk, which
divides into a small posterior ramus and large
anterior ramus, both containing motor and
sensory fibers.
∙ The posterior or dorsal ramus divides the into
lateral and medial branches which supply the
muscles. One of them sends a branch called Fig. 9.14: Typical thoracic spinal nerve

posterior cutaneous branch which divides into

lateral and medial branches.
 PERIPHERAL NERVES
∙ The anterior or ventral ramus runs
anterolaterally around the body wall to supply
the muscles and skin of the anterolateral wall
of the body.
∙ In thoracic region, large ventral ramus forms
intercostal nerve that runs along the lower
border of the corresponding rib and supplies
intercostal muscles. It gives lateral and
anterior cutaneous branches. Fig. 9.14: Typical thoracic spinal nerve
 PERIPHERAL NERVES
Distribution of Sympathetic Fibers through
Spinal Nerves:

∙ Lateral horn cells are present in thoracic, upper

lumbar, and sacral regions of spinal cord.
∙ Sympathetic fibers arising from lateral horn
cells enter the ventral root and then the chain of
sympathetic ganglion via nonmyelinated gray
rami communicantes. Postganglionic
sympathetic fibers join spinal nerve through Fig. 9.14: Typical thoracic spinal nerve

myelinated white rami communicantes.

 PERIPHERAL NERVES
∙ These sympathetic fibers supply the smooth
muscle of blood vessels and muscles
associated with hair (arrectores pilorum) and
sweat glands.

Fig. 9.14: Typical thoracic spinal nerve

 PERIPHERAL NERVES
Dermatome:

∙ It is the area of the skin supplied by a

single spinal nerve.
∙ During embryonic development in limbs,
dermatomes are migrated away from the
trunk. During this migration, they carry
their nerves and vessels.

Fig. 9.15: Overlapping of the dermatome

∙ Segmental overlap - There is varying degree of overlap of
adjoining dermatomes. Hence, area of sensory loss in
damage to a particular spinal nerve is always less than the
area of distribution.

Figure 9.16: Dermatome mam or pattern of peripheral

distribution of spinal nerves
 PERIPHERAL NERVES
Plexus Formation by Spinal Nerves :

∙ The anterior primary rami of the spinal nerves join and then split again to form a
network of nerves called nerve plexuses. There are three major nerve plexuses:
1. Cervical plexus - the ventral primary rami of Cl, C2, C3, and C4 spinal nerves. It
innervates the head and neck.
2. Brachial plexus - the anterior primary rami of C5, C6, C7, C8, and Tl. It
innervates the upper limb.
3. Lumbosacral plexus - formed by L1, L2, L3, L4 and Sl, S2, S3. It innervates the
lower limb.
 REFLEX ACTION
∙ Definition -A reflex action is an automatic, rapid, and involuntary response to a stimulus
without conscious thought.
∙ It is a fundamental protective mechanism against potentially harmful or dangerous stimuli.
They occur without the involvement of the brain's conscious processing.

Reflex arc :

∙ It is a neural pathway that controls a reflex action.

∙ Components of reflex arc include:
1. Sensory Receptor - The process begins with a sensory receptor, which detects a stimulus
(such as heat, pain, or pressure) in the peripheral nervous system (PNS).
2. Sensory Neuron - The sensory receptor sends a signal through a sensory neuron (also
known as an afferent neuron) to the spinal cord.
3. Integration Center - In the spinal reflex arc, the sensory neuron synapses with an
interneuron (also called an association neuron) within the spinal cord.
 REFLEX ACTION
1. Motor Neuron - The interneuron sends a signal through a motor neuron (also known as
an efferent neuron) away from the integration center. The motor neuron carries the
response signal to an effector organ, typically a muscle or gland.
2. Effector Organ - The motor neuron stimulates the effector organ, which carries out the
response, such as muscle contraction or releasing a hormone.

Examples of reflex actions:

2. Knee-Jerk Reflex (Patellar Reflex)

3. Biceps Reflex
4. Withdrawal Reflex (Flexor Withdrawal Reflex)
5. Crossed Extensor Reflex

6. Gag Reflex
Fig. 9.17: Biceps tendon reflex (right)
Table 9.5: Examples of reflex actions and their neuronal pathways

Reflex Action Stimulus Spinal Segments Efferent Response

Neuron
Knee-jerk reflex Tapping patellar Lumbar (L3, L4) Motor neurons Leg kicks forward involuntarily
tendon to quadriceps
muscle
Biceps reflex Tapping biceps Cervical (C5, C6) Motor neurons Forearm jerks upward involuntarily
tendon above the to biceps brachii
elbow
Withdrawal reflex Painful stimulus Varies (Depends on Motor neurons Body part moves away from painful
(e.g., touching hot location of stimulus) to flexor stimulus
surface) muscles
Crossed extensor Stepping on a sharp Lumbar (L3, L4) for Motor neurons Flexor muscles contract (withdrawal
reflex object with one foot injured leg; Lumbar and to flexor reflex) in injured leg, extensor muscles
Thoracic for opposite (injured leg) and contract in opposite leg to support body
leg extensor weight
(opposite leg)
muscles
Gag reflex Touching back of Brainstem (Medulla Motor neurons Throat and pharynx muscles contract,
the throat or uvula oblongata) to pharyngeal preventing foreign object entry
muscles
 AUTONOMIC NERVOUS SYSTEM
∙ The autonomic nervous system regulates involuntary activities of the body such as blood
pressure regulation, size of pupil, digestion, peristalsis, secretions of glands, heart rate, and
so on. Hence, it is also called visceral nervous system.

Divisions of Autonomic Nervous System:

• The autonomic nervous system is divided into three divisions:

1. Sympathetic nervous system

2. Parasympathetic nervous system

3. Enteric nervous system

 AUTONOMIC NERVOUS SYSTEM
Sympathetic nervous system:

∙ It consists of preganglionic fibers,

sympathetic ganglia, and postganglionic
fibers (Fig. 22.1). Its preganglionic
fibers arise from the lateral horn cells of
thoracic and upper two lumber spinal
segments (T1 to T12, L1 and L2); hence
it is called thoracolumbar system or
outflow. The sympathetic ganglia are
connected with each other, and they form
sympathetic chain. The postganglionic
sympathetic fibers reach the targeted Fig. 9.8: Practice figure: Sympathetic and parasympathetic
viscera through adjacent spinal nerves or nervous system (schematic representation)
by forming plexuses around the adjacent
arteries.
Parasympathetic nervous system:
∙ It also consists of preganglionic fibers,
parasympathetic ganglia, and
postganglionic fibers.
∙ Its preganglionic fibers arise from
o Nuclei of cranial nerves in the
brainstem
o Lateral horn cells of S1–S3 spinal
segments.

Fig. 9.8: Practice figure: Sympathetic and parasympathetic

nervous system (schematic representation)
 AUTONOMIC NERVOUS SYSTEM
∙ Hence, the parasympathetic nervous system is called craniosacral system or outflow.
∙ The parasympathetic ganglia are located near the viscera, mostly in wall of the organs. The postganglionic
parasympathetic fibers are shorter.

Enteric nervous system:

∙ It is a network of neurons located in the wall of intestine.

∙ It consists of :
1. Neuronal network
2. Meissner’s plexus in submucosa
3. Auerbach’s (myenteric) plexus in between outer longitudinal and inner circular muscle coats of muscularis
externa.
∙ It controls movements (peristalsis) and secretions of gastrointestinal tracts. Enteric nervous system is controlled
by sympathetic and parasympathetic nervous system and secretions of cells of gut.
 Sympathetic nervous system Parasympathetic nervous
system
Outflow Thoracolumbar system or Craniosacral system or outflow
outflow
Origin Thoracic and L1–L2 spinal Brainstem
cord
S1–S3 spinal segments
Preganglionic fibers Short Long
Myelinated Myelinated
Release acetylcholine Release acetylcholine
Ganglia Located near spinal cord Located near viscera
Postganglionic fibers Long Short
Nonmyelinated Myelinated
Postganglionic fiber Adrenaline, noradrenaline, Acetylcholine
neurotransmitter acetylcholine
Major function Fight and flight mechanism Conservation of energy and
growth

Table 9.6: Major differences between sympathetic and parasympathetic nervous system
 Viscera/parameter Sympathetic effect Parasympathetic effect
Heart Increases heart rate, force of contraction, Decreases heart rate, force of
and cardiac output contraction, and cardiac output
Blood pressure Increases Decreases
Blood vessels In skin and gut – vasoconstriction No effect
In skeletal muscles – vasodilatation
Respiration Increases respiratory rate Decreases respiratory rate
Bronchial smooth muscles Bronchodilatation Bronchoconstriction
Gastrointestinal tract Peristalsis – decreases Peristalsis – increases
Sphincters – contract Sphincters – relax
Secretions – decrease Secretions – increase
Urinary bladder Inhibits urination Induces urination
Eye Pupil – dilatation Pupil – constriction
Lacrimal and salivary Thick secretion Watery secretion
glands
Sweat glands Sweating No effect
Arrector pili muscle Contraction No effect

Table 9.7: Functional differences in sympathetic and parasympathetic nervous systems

 AUTONOMIC NERVOUS SYSTEM
Visceral Sensation:

∙ The autonomic nervous system carries few afferent nerve fibers as general visceral afferent
neurons.
∙ The cell bodies of these neurons are located at

a. Dorsal root ganglion of spinal nerves

b. Sensory ganglia of cranial nerves.

∙ These sensations are helpful as:

1. They carry visceral pain sensation.

2. Elicit visceral reflexes at unconscious level.

3. Elicit the hunger, thirst, nausea, urination, and defecation sensation.

 Clinical Integration
∙ Visceral pain - The autonomic
nerves carry visceral pain sensation.
It is dull, poorly localized sensation.
Visceral pain is usually referred to
the skin (dermatome) that is
innervated by the same spinal
segment.

Fig. 9.19: Important sites of referred pain

∙ Anatomical basis - Through the spinal cord,
the visceral pain sensation reaches the area of
sensory cerebral cortex, which represents the
specific skin area (dermatome). Hence, the
visceral origin of pain can not be differentiated
at conscious level. The sites of referred pain
are as follows:
Heart – left precordium, inner aspect of arm
and forearm
Gallbladder – tip of right shoulder
Spleen – tip of left shoulder
Diaphragm – tip of corresponding shoulder
Appendix, testis, and ovary – skin around the
umbilicus. Fig. 9.19: Important sites of referred pain
Thank You